Comparison of two external manoeuvres with the conventional technique on glottic visualisation using a C-MAC® videolaryngoscope in children for elective surgery

BACKGROUND AND AIMS: Glottic visualization is a pre-requisite for successful intubation. We compared the effect of backward upward rightward pressure (BURP) and jaw thrust manoeuvres with the conventional technique on glottic visualisation using a C-MAC® videolaryngoscope in children of 3 to 10 years. METHODS: Ninety children of either gender of 3 to 10 years with normal airways and of the American Society of Anesthesiologists grade I or II for elective surgery under general anaesthesia with endotracheal intubation using a C-MAC® videolaryngoscope were enroled. Glottic views with the conventional technique (C), BURP (B), and jaw thrust (J) manoeuvres in three groups were assessed by modified Cormack Lehane grade (MCL) grade, percentage of glottic view (POGO) score, and a new two-dimensional metric – approximate glottic opening area in pixels squared. Approximate glottic opening area calculations were performed using tool pencil in horos medical imaging software. RESULTS: Jaw thrust had statistically significant superiority over the conventional technique and BURP on glottic visualisation (a p value of C vs J < 0.0001 and B vs J < 0.05 for all the three parameters). BURP was comparable to the conventional technique in MCL grade and POGO score (a p value of C vs B > 0.05) but was superior to the conventional technique in glottic area (a p value of C vs B = 0.013). CONCLUSION: Jaw thrust enhanced glottic visualisation by maximising all the glottic view parameters as compared to the BURP manoeuvre and the conventional technique and should be considered the primary manoeuvre to aid intubation in children.